*Purpose: Prolongation of the systolic acceleration time (SAT) and decreased resistive index (R/I) of the proper hepatic artery following liver transplant have been associated with increased anastomotic-associated complications including hepatic artery stenosis and thrombosis. Often, surgeon preference guides the decision of anastomosis configuration, as currently no literature exists to describe whether the final anatomy of the hepatic artery influences SAT and R/I. We aimed to explore whether post-operative hepatic artery anastomosis anatomy configuration influenced doppler SAT and R/I values following liver transplantation.

*Methods: 75 patients who underwent deceased donor orthotopic liver transplant were evaluated. Operative records, baseline characteristics and doppler values within the first post-operative liver doppler ultrasound following transplantation were reviewed. Final anastomosis configuration was noted from operative record review and the five most common types were grouped (Figure 1). Variables were analyzed by anastomosis group and included R/I, SAT, proper hepatic artery (pHA) flow rate, and rate of hepatic artery thrombosis/stenosis.

*Results: Among the five anastomosis groups, no statistically significant differences in pHA flow rate, R/I , or rate of hepatic artery stenosis/thrombosis were observed (Table 1). Splenic artery patch (donor) to right/left bifurcation (recipient) anastomosis configuration was associated with lower SAT when compared to common hepatic to right/left bifurcation anastomosis (30.0ms vs. 43.6ms, p=0.02), aortic carrel patch to right/left bifurcation (30.0ms vs 46.5ms, p=0.03), and splenic artery patch to gastroduodenal artery patch (30.0ms vs. 50.0ms, p=0.03).

*Conclusions: Although not associated with increased rates of hepatic artery thrombosis or stenosis, a donor splenic artery patch to recipient right/left hepatic artery bifurcation anastomosis configuration was associated with decreased SAT. Current practices, which favor common hepatic to right/left bifurcation anastomosis may not maximize optimal flow dynamics for the hepatic artery anastomosis during liver transplantation.

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